Archive for October, 2008

Almost 6 months post-transplant…

October 30, 2008 Leave a comment

Everything is still pretty much status-quo. I’ll hit another milestone; Monday will be my 6 month anniversary of my transplant. I have appointments next week in the Transplant Department with both the Surgeon and Nephrologist. I anticipate that the surgeon will allow  me to stop the Valcyte and Dapsone, as well as to cut me back on my immunosuppressants.

I was getting my morning coffee yesterday in the lobby of the clinic, and there was an employee who was on orientation there. It turns out that this is her first week back to work since last November, after her kidney transplant. After talking to her, there were striking similarities, other than the fact that we both work here. She also has Polycystic Kidney Disease and received a pediatric kidney.

It was interesting talking to her, as I only get to communicate with other transplantees via the internet. She had done dialysis, but had the opposite experience that I did. She had many problems with her fistula, they were never able to get her dry weight correct (dry weight is the estimated goal that they use to determine how much fluid to take off at dialysis; taking off too little will obviously cause fluid overload, and taking off too much can lead to dehydration), and she frequently had cramping. Now, for those readers who’ve woken up with a muscle cramp in their leg, that is NOTHING compared to the cramps you get on dialysis. I’ve only had them on 2 occasions, and as I mentioned before, they are so severe that I practically cried (there are only 2 reasons I have cried with pain since I’ve been an adult: cramps on dialysis, and when a kidney cyst was in the process of rupturing).

She also had to have her immunosuppression changed. She is currently only on Prograf; they stopped her CellCept when she tested positive for BK virus.

Her kidney is doing great otherwise-a creatinine of 1.0 since the very first lab draw after her transplant. She received a kidney from an 11 year old boy who was playing in an attic, found a gun that was loaded, and accidently shot himself.

This week at work, we had a 5 year old in for an unprovoked bite by a “barn cat”; this cat had an open leg wound previously. They initially treated her with an antibiotic, and the father was to try to catch the cat (cat bites can cause nasty infections, since it’s a closed puncture wound; a dog bite is usually a tear, which can be cleaned out and is less likely for infection). Well, the father did catch the cat, and the head was sent to a lab in Harrisburg late Tuesday; the results came back yesterday, and the cat was positive for Rabies. The leg wound the cat had was probably from a rabid animal.

She came back in yesterday to begin Rabies PEP (post exposure prophylaxis), and tolerated it amazingly well. In addition to a vaccine in her arm, the doctor had to stick a needle in her leg, and inject 3 ml of very thick (and thus very painful)  Rabies Immuno Globulin all around the bite in the back of her calf (Rabies IG is antibodies extracted from blood of people vaccinated with Rabies Vaccine). No crying or even moving; she just said that it felt like bee stings.

My theory is that the child’s reaction was mostly on how she has learned to react to painful situations from how her parents react (although pain threshhold and tolerance probably play a part). Her mother was very stoic and matter-of-fact about it, so the child was as well. Quite a contrast to the parents who make a huge deal of checking a child’s temperature rectally. When I do this, it’s not uncommon for a comment from a parent.

I will be SO glad when November 4th is done;  I’m sick of hearing all of the political ads.


It’s been awhile…

October 22, 2008 Leave a comment

Time flies when you work 7 days a week! I’m not complaining; in fact, I’m GLAD that I’m physically able to do it. What a difference a few months make. Back in April, I was still working full-time, and doing 12 hours a week of dialysis on top of that, but I either slept or rested every chance I got.  Now, I sleep about 5-6 hours a night, don’t take any naps, and still am ready to go!

I’m closing in on the 6 month post-transplant mark now, which means less immunosuppression, and thus, less meds. I had labs 2 weeks in a row now due to decreasing my Prograf, and everything looks good (I hope to get a copy of today’s labs so that I can post them tomorrow). Today, my creatinine is 1.3 (I was lazy with fluid intake, so it’s up a bit, but not at all worrisome; you can tell my hydration isn’t the greatest by the BUN being a little elevated as well). The good news is my hemoglobin FINALLY hit 12 today; the highest it’s been since before my transplant in May. Maybe no more Procrit soon?

I often wonder what the status is of my “native” kidneys. When my mother had hers removed in preparation for a transplant, hers were practically nonexistant, as she had been on dialysis for 3 years at that point (the only reasons they remove them now is for infection, excessive pain, to make room for a transplant, and a handful of other reasons). I get a reminder a few days a week that they are still there, when a get twinges of pain. The pain is sharp for a brief 1-2 seconds, and then goes away.

I’m still walking at least 4 times a week on my lunch break, and feel better doing so. This has created some issues with my feet (worsened calluses), but maybe I’ll get to the Podiatrist to see if he can do anything to help.

Today, Digger was very proud. He killed his first rabbit, and was feasting on it in our back yard (he’s our 3 year old GoldenDoodle).  He also pranced around the yard with it in his mouth, with his head held high, and his tail up in the air. I didn’t yell at him, because it’s natural instinct for him. The way I look at it is that if the rabbits dig holes under our fence, and are stupid enough to come into a yard with 3 dogs, that’s the chance they take.

I’ve been working in the clinic now for over 14 years, yet there is always something new that presents itself. I get to see first hand, the entitlement attitude of some people, but this week beats them all. In another department on the same floor I work on, a lady of about 46 called to ask the doctor to write a letter. You see, she’s healthy, except for the chronic back pain she has, for which she gets LOTS of Percocet (well over 100 tabs per month). She is on a Medicaid managed care plan, and told the person answering in our clinic that she called her “insurance company”, and was told that if she got a letter from the doctor, she may be able to get reimbursement from Medicaid for the costs incurred with her horses (yes, that’s plural). You see, she rides her horses as therapy for her back pain, so this is actually a medical expense. I was a little confused, because the LAST thing I would do is to ride a horse if I had chronic severe back pain. But for me, it’s a moot point, because I’m too busy with work and other responsiblities to have TIME to ride a horse. If your not miffed with this, then I guess it wouldn’t bother you much if you found out that this same Medicaid company also pays for tubal ligations to be reversed. Our tax dollars at work (although I don’t have any problem with Medicaid providing insurance to those who truly need it, and can’t afford it).

I’ll be glad when the election is over. Here in Northeastern PA, we are being BOMBARDED with political ads. Although the polls don’t show it, Pennsylvania is still very much in play for the Presidential election (a poll of registered voters is much less accurate than a poll of likely voters, and there are MANY other factors which can make a poll inaccurate).  In addition, our Congressman was in the thick of things with the Fannie Mae/Subprime mess, and for the first time since winning 24 years ago, it is likely that he will lose his seat.  Less than 2 weeks to go, and that’s a good thing….


October 9, 2008 1 comment

CEO –Chief Embezzlement Officer.CFO– Corporate Fraud Officer.

BULL MARKET — A random market movement causing an investor to mistake himself for a financial genius.

BEAR MARKET — A 6 to 18 month period when the kids get no allowance, the wife gets no jewelry, and the husband gets no sex.

VALUE INVESTING — The art of buying low and selling lower.

P/E RATIO — The percentage of investors wetting their pants as the market keeps crashing.

BROKER — What my broker has made me.

STANDARD & POOR — Your life in a nutshell.

STOCK ANALYST — Idiot who just downgraded your stock.

STOCK SPLIT — When your ex-wife and her lawyer split your assets equally between themselves.

FINANCIAL PLANNER — A guy whose phone has been disconnected.

MARKET CORRECTION — The day after you buy stocks.

CASH FLOW– The movement your money makes as it disappears down the toilet.

YAHOO — What you yell after selling it to some poor sucker for $240 per share.

WINDOWS — What you jump out of when you’re the sucker who bought Yahoo @ $240 per share.

INSTITUTIONAL INVESTOR — Past year investor who’s now locked up in a nuthouse.

PROFIT — An archaic word no longer in use.  (It was difficult to find in my Thesaurus …)



Categories: Humor Tags: ,

Monthly Transplant Surgery Appointment, Labs

October 8, 2008 Leave a comment

I had my monthly appointment with the Transplant Surgeon today; the Transplant Nephrologist didn’t have any openings, so I’ll see him next month.

I don’t have my labs to post, but did see them. My creatinine is still at 1.2, and my hemoglobin is 11.5. I’m still on Procrit, and checked via email with the Nephrologist; he will stop it when my hemoglobin hits 12.5. My WBC is still good; IIRC, it’s 3.4. I thought it might go lower since doubling the Valcyte, but it didn’t drop too much. The surgeon feels at this point that the hardened area at my incision site is some scar tissue, and that the hematoma is resolved. He was very pleased with my progress, and I can now have my labs done monthly (I had been doing them bi-weekly). Yeah!

The Transplant Department ordered a wrong lab AGAIN; they ordered a CMV DNA Qualitative (positive or negative), instead of the Quantitative (which gives an actual number). This is the second time this has happened, and I believe it was the secretary who made the error. It happened last month as well, and caused a lot of problems; more about that in a future post.

I’ve been walking now on a regular basis, now that I have my AFO’s adjusted, and feel a lot better. I walk every day at work, Monday to Friday, for about 30 minutes, with half of it up hill. I’ve noticed that if I play my Ipod while walking, I walk faster, and get my heart rate up more.

BP is running in the 120’s/70’s, and the surgeon was thrilled with that. Quite amazing, since I had been on blood pressure meds for well over 15 years, and now, I don’t need any. I’m making an effort to increase my protein intake, since with the gastric bypass, I tend not to get enough in. I’ve been snacking on soy nuts (it’s an acquired taste, especially since they are unsalted), and found an absolutely delicious yogurt that I eat each morning-it has 16 grams of protein and 140 calories per serving!

A friend at work is having a colonoscopy tomorrow, so I sent him a link to this video to help him through it.

And for those who need a little humor, whether you are liberal or conservative, Democrat or Republican (or even Libertarian), you need to watch this.

Transplant Week 21, Other Stuff

October 1, 2008 Leave a comment

The farther out I get from my Kidney Transplant, the less I have to write about (as I’ve said before, I’ll take  boring).

I had labs done last week, and my Creatinine is rock stable at 1.2, my Hemoglobin has leveled out at 11.3 for the past month and a half (still on Procrit), and my Prograf level took a fairly large jump.

I doubled my Valcyte the week before, and my WBC dropped noticeably from 5.2 to 3.9. I predict that I’ll get Neutropenic again, and have to go to once a day Valcyte. As for the Prograf, I took my dose late the night before (I had a “dumping” episode from eating a small amount of ice cream), so it’s possible that I took it later than I thought, and thus drew my labs an hour early.

Appointment next week with the Transplant Surgeon, but not with the Nephrologist.  I’ll also have labs as well.

I just put up a new entry at my blog at MyKidney.  It involves the story of a 21 year old (Sam Pifer) who signed an organ donor card, died of a head injury, and had his organs harvested against his parents’ wishes.

Jackie and I went to Bethlehem this past Saturday to a Celtic Music Festival.  We mainly went to see The Elders, and again, we weren’t disappointed. Many in the crowd weren’t disappointed, and I’m sure they picked up a lot of new fans. (you can hear samples of their albums here). We also caught part of the previous band, The Town Pants. I probably will download an album or 2 of theirs off of iTunes; their fiddle player was awesome.

Confused about the “Bailout”? My personal opinion is that the plan is just another BOHICA from those we elected to represent us.  Giving 700,000,000,000 to 1,000,000,000,000 to the Treasury Secretary to “fix” the problem that was caused by greedy politicians and executives at Fannie Mae and Freddie Mac is akin to letting the fox guard the henhouse, not to mention all of the pork that will be piled on top of this money.  Jeffrey Miron, a lecturer on economics at Harvard has an excellent commentary on the bailout. Worth reading.

Speaking of the Bailout, I decided to contact my 2 Senators who will be voting on the Senate bailout plan this evening. I first phoned Bob Casey’s office, and the phone was answered on the first ring. I gave my opinion, she asked my zip code, and was ready to hang up. But I asked her if she was going to take my name; replied that she wasn’t. When I asked why, she told me it was because “we are getting too many calls”. I hung up; so much for my Senator caring about his constituents’ opinions. I tried numerous times to contact Arlen Spector’s office, and got either a busy signal, or a “circuits busy” message.  Pennsylvania had a movement called PA Clean Sweep after the thiefs Assemblymen in the Pennsylvania General Assembly tried to vote themselves a raise in a session held in the middle of the night. I personally hope that such a movement takes hold nationally.

Medical Article Scan September 2008

October 1, 2008 Leave a comment

MMR Vaccine Not Linked to Autism yet ANOTHER study disproving the link, although as this article points out, Although true believers in the theory of a relationship between MMR vaccine and autism will probably not be dissuaded…

Chronic Kidney Disease Heightens Medical-Error Risk this is a study of 250,000 patients in Veteran’s  Hospitals. Key points: the increased risk was linearly related to the severity of kidney disease, The researchers looked for records of 18 complications that are potentially preventable, and their data don’t distinguish between events caused by healthcare and those related to the underlying kidney disease.

Mother’s Flu Shot Protects Newborns when I first started out as a RN in Peds 19+ years ago, influenza was not really considered in infants that were symptomatic. In fact, flu shots were only given to those at “high risk”, such as those with chronic illnesses. Now, the flu vaccine is recommended for ALL patients in our practice up to 18 years of age. This study has concluded that pregnant mothers who get vaccinated while pregnant can pass on protection to their child prior to delivery.

Living Donor Liver Transplants May Drastically Decrease Mortality From Liver Failure Acute Liver Failure (quick onset as opposed to chronic liver failure, which is gradual) may be able to be treated with living donor donation for transplant. I’ve always said that I’m lucky; if I didn’t get a kidney, I could do dialysis; if I needed a liver and didn’t get it, I would die. I hope this pans out.

High Blood Pressure Takes Big Toll On Small Filtering Units Of The Kidney  Although this isn’t exactly previously unknown, scientists are getting closer to figuring out how the glomeruli are affected by hypertension. If you have high blood pressure, this underscores how important it is to get it treated effectively.